알콜리즘에서 Buspirone에 대한 Cortisol과 Prolactin 반응

심주철,이정구,김정익,이유철,김영훈 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.2

연구목적: 본 연구는 buspirone에 대한 cortisol과 prolactin 반응을 통해 알콜리즘에서 5-HT1A 수용체기능을 조사하고자 하였다. 방법: 알콜리즘 환자군은 DSM-IV의 알콜리즘 진단기준에 부합되고 금주기간이 최소 3개월 이상이며 우울 및 불안증상이 없는, 한 정신병원 알콜 센터에 입원한 22명의 남자 환자였다. 대조군은 정상성인 남자 15명이었다. 이들에게 오전 9시에 5-HT□ 효현제인 buspirone 30mg을 경구 투여한 후 0, 30 , 60, 90, 120, 150분의 혈청 cortisol과 prolatine 농도를 측정한다. 결과: 환자군과 대조군간에 cortisol 기저치에는 유의한 차이가 없었다. Buspirone 투여 후 혈청 cortisol 농도는 정상대조군에서는 기저치에 비해 유의한 증가를 보였으나(p<0.01) 환자군에서는 유의환 증가가 없었다. 혈중 cortisol 농도는 buspiron 투여 60분 이후부터 환자군에서 정상 대조군에 비해 유의하게 저하되어 있었다(p<0.05). Buspirone에 대한 혈청 prolactin 반응은 환자군과 정상대조군간에 유의한 차이가 없었다. 결론: Buspirone 투여 후 둔마된 혈청 cortisol 반응을 통해 알콜리즘에 5-HT1A 수용체 반응성이 둔마되어 있음을 확인할 수 있었다. Objectives: The purpose of this study was to evaluate the prolactin and cortisol responses to 5-HT1A receptor activation by buspirone in alcoholics. Methods: The subjects were twenty two male alcoholic patients meeting the DSM-IV criteria for alcohol dependency and abstaining for more than 3 months. Patients were free from overt anxiety and depressive symptoms. Controls were fifteen male normal volunteers, with no psychiatric and medical illness. Blood samples for the measurement of serum cortisol and prolactin levels were drawn 0, 30, 60, 90, 120, 150 minutes after oral administration of 30mg buspirone hydrochloride at 9:00a.m. Results: The baseline cortisol levels were not significantly different between alcoholics and controls. Serum cortisol levels of controls after buspirone administration were significantly increased over time(p<0.01), but those of alcoholics did not increased. After 60 minutes following buspirone administration, cortisol levels were significantly lower in alcoholics than in contrlos(p<0.05). Prolactin responses to buspirone were not significantly different between the two groups. Conclusions: Our results suggested that 5-HT1A receptor function is decreased in alcoholic patients.

만성 정신분열병 환자에서 지연성 운동장애와 음성증상 및 인지기능 장애와의 연관성

심주철,반철식,성기수,이정구,정도운,정청,윤진상,김영훈 대한신경정신의학회 2000 신경정신의학 Vol.39 No.4

연구목적: 정신과 전문병원에 입원해 있는 만성정신분열병 환자들을 대상으로 첫째 지연성 운동장애의 유병율과 위험인자들을 조사하고, 둘째 지연성 운동장애와 정신분열병의 음성증상 및 인지기능 장애와의 상관성을 조사하고자 한다. 방법: 연구대상자는 마산동서병원에 입원 중인 환자 중 DSM-IV의 정신분열별 진단기준에 부합하며, 최근 3개월 이상 동일 용량의 항정신병약물 복용한 271명(남자 174명, 여자 97명)의 환자들이었다. 지연성 운동장애에 대한 평가는 Abnormal Involuntary Movement Scale(AIMS)을 이용하였고, DSM-IV와 Sc-hooler와 Kane(1982)의 진단기준 양자에 부합하는 환자들만을 지연성 운동장애군으로 분류하였다, 정신 분열병 정신병리에 대한 평가는 Brief Psychiatric Rating Scale(BPRS)와 Schedule for the Deficit Syndrome(SDS)을 이용하였고, 인지기능에 대한 평가는 Mini-Mental Status Examination(MMSE)을 이용하였다. 결과: 지연성 운동장애의 유병율은 50.9%이었고, 50세 이상, 남자에서 높았다. 그러나 입원기간과 항정신병 약물의 일일 사용량에 따른 차이는 없었다. 지연성 운동장애의 호발부위는 혀, 상지, 입술과 입 주위의 순이었다. BPRS 총점 및 소항목 척도점수와 SDS 척도점수는 지연성 운동장애의 유무에 따른 차이가 없었다. MMSE 총점 및 소항목 점수도 지연성 운동장애의 유무에 따른 차이가 없었다. 결론: 평균입원기간이 9년 이상인 만성정신분열병 환자들에게서의 지연성 운동장애의 유병율은 50.5%이었고, 연령이 가장 의미있는 위험인자임을 확인했다. 만성정신분열병 환자들이 주 대상인 본 연구에서는 지연성 운동장애와 정신분열병의 음성증상 및 인지기능 장애와의 상관성은 입증하지 못했다. Objectives: The purpose of present study was to determine the prevalence rate of tardive dyskinesia and to search for its risk factors in chronically institutionalized schizophrenic subjects. We also examined the relationship between tardive dyskinesia and both negative symptoms and cognitive impairments in the same subjects. Methods: Subjects were 271 in-patients(174 males, 97 females) at Masan Dongsuh Hospital. They met DSM-IV criteria for schizophrenia and had been taking fixed doses of antipsychotics for at least 3 months. Tardive dyskinesia was assessed by Abnormal Involuntary Movement Scale(AIMS). Cases of tardive dyskinesia were ascertained by the criteria of Schooler and Kane (1982) and DSM-IV. The rating of psychopathology was acquired using Brief Psychiatric Rating Scale(BPRS) and Schedule for the Deficit Syndrome(SDS) and the assessment of cognitive function using Mini-Mental State Examination(MMSE). Results: The prevalence of tardive dyskinesia is 50.9% and the frequency of tardive dyskinesia was high est in male above the age of fifty. But there was no statistically significant relationship between the frequency of tardive dyskinesia and both the length of hospitalization and the daily dose of antipsychotics. The frequency order of abnormal movement in the patients with tardive dyskinesia was as follows : tongue, upper extremities, lips and perioral area. We couldn't find any significant difference in the total and subscale scores of BPRS between the groups with and without tardive dyskinesia. There were no differences in MMSE scores between the groups with and without tardive dyskinesia. Conclusion: This study gave us that the prevalence of tardive dyskinesia was high in chronically institutionalized schizophrenic inpatients and that age was the most significant risk factor of tardive dyskinesia. The relationship between tardive dyskinesia and both negative symptoms and cognitive impairment, however, was not revealed.

리스페리돈으로 유발된 무월경에 대한 아리피프라졸 부가치료

심주철,공보금,정도운,강제욱,오민경 대한정신약물학회 2011 대한정신약물학회지 Vol.22 No.1

본 연구는 아리피프라졸 부가치료가 리스페리돈으로 인해 발생되는 고프로락틴혈증 및 이와 동반된 무월경 치료에 효과적임을 지지했다. 그러나 아리피프라졸 부가치료가 리스페리돈 감량, 도파민 효현제 부가 치료, 아리피프라졸 단독 투여로 교체하는 방법들과 비교해서 효과, 안정성 및 경제성에서 우수한가에 대해선 여전히 검증이 필요하다. 리스페리돈에 의해 유발된 무월경치료에 어느 방법을 선택할 것인가는 환자의 개인적인 특성을 고려한 임상의의 판단이 중요하리라 사료된다. ObjectivezzHyperprolactinemia and associated side effect, amenorrhea, often occur with risperidone treatment. We investigated the effect of adjunctive treatment with aripiprazole on risperidone induced amenorrhea in female patients with schizophrenia. MethodszzA retrospective chart review of 24 female patients with adjunctive aripiprazole treatment for risperidone induced amenorrhea between August 2008 and July 2009 was conducted. The information collected included age, menstrual cycle, duration of no menstruation, prolactin level (before aripiprazole treatment and after regaining menstruation), dose of risperidone and aripiprzole, time from starting aripiprazole adjunctive treatment to regaing menstruation. The Student’s t-test, Pearson’s Chi-square test were used for data analysis. ResultszzMean percent decrease in prolactin level for all aripiprazole-treated patients was 71.4±8.6%. 85.7% (18/21) of patients resumed menstruation, while 14.3% (3/21) did not regain. In patients with regaining menstruation, mean time from starting aripiprazole to restarting menstruation was 6.6±2.4 weeks, mean dose of aripiprazole was 12.2±3.9 mg/day (dose range, 5 mg to 20 mg/day). Aripiprazole dose for regaining menstruation was not significantly correlated with baseline prolactin level. CGI score was not significantly changed after aripiprazole treatment. The cutoff point of prolactin level significantly increasing amenorrhea was 40 ng/mL. ConclusionzzAdjunctive aripiprazole treatment is very effective to treat risperidone induced amenorrhea in female patients with schizophrenia.

정신분열병 환자의 우울증에서 Paroxetine과 삼환계 항우울제 병용치료

심주철,공보금,박정환,윤영란,신재국,김정익,안동성,김용관,차인준,김영훈 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.4

저자들은 마산동서병원에 입원중인 우울증이 동반된 정신분열증 환자 10명을 대상으로 사용중인 항정신병약물에 paroxetine과 저용량의 삼환계 항우울제를 6주간 병용투여한 후 우울증상에 대한 효과와 치료의 안전성 및 약물상호작용을 알아보았다. Paroxetine은 고정량의 항정신병약물과 삼환계 항우울제에 부가하여 일일 20㎎을 6주간 병용하게 하였으며, 임상상태는 HDRS, HARS, UKU Side Effect Rating Scale등의 평가척도를 사용하여 평가하였다. 또한 약동학적 약물상호작용은 삼환계 항우울제들의 혈장농도를 HPLC로 측정하여 분석하였다. 결과는 다음과 같다. 1) 10명의 전체 대상환자에서의 HDRS 평균점수는 TCA와 paroxetine 병용투여 6주후에 통계적으로 유의하게 감소되었다. 이중 40%의 환자에서는 병용투여 6주후에 HDRS 점수상 50% 이상의 감소를 보여, 일부의 환자들에서는 정신분열병에 동반된 우울증상의 치료에 소량의 삼환계 항우울제와 paroxetine의 병용치료가 효과가 있음을 확인하였다. 2) 두 명의 환자에게서 심각한 약물독성이 발생하였다. 이중 한 명은 삼환계 항우울제의 높은 혈중농도로 인한 항콜린성 위기(anticholinergic crisis) 소견을 보였으며, 다른 한 명은 인지기능 및 의식수준은 명료하였으나 망상과 환각증상이 약화되는 소견을 보였다. 따라서 본 연구에서 시도된 복합적 약물치료의 경우, 삼환계 항우울제의 혈중농도의 측정을 포함한 세심한 임상적 추적이 필요하다고 생각된다. 3) 기저치의 amitriptyline과 그 대사물인 nortriptyline의 농도합. imipramine과 대사물인 desipramine의 농도합은 각각 47.8-226.5ng/㎖. 80.5-395.6ng/㎖였으며 일반적으로 이들 약물들의 단독사용시에 문헌에 보고된 혈중농도를 훨씬 상회하고 있었다. 이는 병용투여된 항정신병 약물 약시 강력한 CYP2D6 효소억제제로서 기저치의 삼환계 항우울제들의 혈장농도를 이미 상당히 증가시켰던 것으로 판단되며, 그러한 결과로 인해 본 연구에서는 paroxetine이 이전의 문헌보고들과는 달리 뚜렷하게 삼환계 항우울제들의 혈장농도를 증가시키지 못하였다. 본 연구는 SSRI와 삼환계 항우울제의 병합 투여가 우울증의 개선 효과를 빠르게 하고, 치료역을 넓히고, 약물상호작용의 결과 paroxetine이 삼환계 항우울제의 혈중농도를 증가시킨다는 기존의 연구결과를 이용하여 정신분열병 우울증상의 치료에 parotextine과 소량의 삼환계 항우울제를 병용하는 방법을 시도해 본 연구이다. 저자들은 이러한 약물치료가 일부의 환자들에게서 효과가 있음을 관찰하였으나, 항정신병약물과 삼환계 항우울제를 병용투여 할 경우는 물론 이에 paroxetine과 같은 선택적 세로토닌 재흡수 억제제를 병용할 경우 복합약물상호작용의 결과로 약물독성의 위험성이 크며 세심한 주의가 필요함을 경험하였다. Depression is well-known to comorbid with several psychiatric disorders. Many schizophrenics also suffer from depression in the course of their illness. Combined therapy of SSRI and tricyclic antidepressants were reported to have benefits in some depressed patients. Paroxetine, a potent CYP2D6 inhibitor, increases the blood levels of tricyclic antidepressant markedly. Using paroxetine, we tried this combined therapy in the treatment of depressive symptoms in 10 chronic schizophrenic inpatients and evaluated its efficacy and drug interactions between paroxetine and tricyclic antidepressants. The following results were obtained : 1) The mean score of Hamilton's Depression Rating Scale(HDRS) was reduced significantly after 6 weeks-trials of this combined therapy for the mild depressive symptoms in 10 chronic schizophrenics. In four patients, 50% or more reductions in the scores of HDRS were noticed at final evaluation. 2) Two among our 10 subjects experienced severe toxic behavioral problems. Anticholinergic crisis with toxic confusion due to high blood levels of tricyclics was found in one patient and the other showed rapid clinical deterioration in his psychotic symptoms such as delusion and hallucination without any consciousness alternation. 3) Baseline plasma levels of tricyclics before adding paroxetine were higher than expected in our chronic schizophrenic subjects maintained with their antipsychotic medications. Several antipsychotics were also known as a potent CYP2D6 inhibitors and to increase the blood levels of tricyclics. Because the blood levels of tricyclics had already increased significantly by the use of antipsychotics, adding paroxetine to antipsychotics and tricyclic antidepressant in our subjects could increase the blood levels of tricyclics not so much as previously reported in the literatures.

정신과 영역에서의 신경펩타이드 자극검사

심주철,김용관 대한생물치료정신의학회 1995 생물치료정신의학 Vol.1 No.2

Many interesting concepts and hypothesis have been advanced with regard to functional role of neuropeptide in psychiatric field. Although the findings of neuropeptide test in psychiatric disorder have helped to elucidate pathophysiological mechanism, they have not provided us with a suitable biological marker. There are no consistent findings for any of neuropeptide challenge test that we haved discussed in terms of their value in differentiating between psychiatric disorders. But many findings have proved to be more valuable as a measure of pathophysiology and as a correlated of treatment response and illness course than a biological marker of the illness. There is a definite need for continuing study in neuropeptide itself, factors influencing neuropeptide, as well as a need to definite underlying genetic processes.

두부 외상후의 정신장애에 대한 임상적 연구

심주철,박태수,진성태 大韓神經精神醫學會 1992 신경정신의학 Vol.31 No.1

This study was performed to investigate the clinical characteristics of the psychiatric disabilities associated with head injury. The subjects were 53 patients who had been admitted to the Pusan Paik Hospital. In je University from Jan. 1986 to Dec. 1990 with the problem of mental symptoms following head injury. The results were summarized as follows : 1) The incidence of psychiatric disability following head injury was higher in male(81.1%). socially-active age group, relatively low educational level, and low socio-economic class. 2) Traffic accident occupied the main cause of head injury, and in the aspect of degree of head injury, cerebral contusion (56.6%) was higher than cerebral concussion (43.4%). 3) In the aspect of premorbid personality, without overt premorbid personality disorder was 49.0%. dependent personality was 9.4%, compulsive personality was 7.5%, and passiveaggressive personality was 7.5%. 4) Posttraumatic neurosis(39.6%) was the most frequent diagnosis, and organic personality syndrome was 22.6%, dementia & amnestic syndrome was 15.1%. organic delusional & hallucinosis was 7.5 %, posttraumatic epilepsy was 5.7 %, organic affective syndrome was 3.8%. 5) EEG & brain CT findings were normal in 60.4% of subjects, and cases of neurosurgical non-operative subjects(81.1 %) were more frequent than operative subjects (18.9%). 6) Mean duration of interval period(duration from head injury to psychiatric treatment), admission period, out-patient period was 105.5. 145.2. 155.0 days respectively, and out-patient period was significantly longer in subjects of organic personality syndrome, posttraumatic neurosis, and posttraumatic epilepsy (p<0.05). 7) Correlation between interval period and out-patient period was positively correlated(r=0.4394. p=0.001).

이갈이 환자의 다면적 인성검사의 특성

박병욱,이희철,장문정,심주철 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.3

연구목적 : 다면적 인성검사를 통해 이갈이군의 심리적 특성을 알아보고 이갈이 환자의 성별, 가족력, 발병기간, 이갈이 유형, 동반된 통증 유무에 따른 심리적 특성의 차이를 알아보고자 하였다. 방 법 : 1998년 1월부터 8월까지 개인 치과의원을 방문한 환자들 중 46명의 이갈이군, 41명의 대조군을 대상으로, 이갈이군과 대조군의 심리적 특성, 이갈이 환자의 성별, 가족력 유무, 이갈이 기간, 이갈이 유형, 통증과 같은 동반증상유무에 따른 심리적 특성의 차이를 알아보기 위해 다면적 인성검사를 실시하였다. 결 과 : 이갈이군이 대조군보다 모든 임상척도에서 높은 점수를 나타냈으나 남성특성-여성특성 척도점수를 제외하고는 통계적 유의성이 없었다. 가족력이 있는 이갈이군이 가족력이 없는 이갈이군보다 반사회성 척도가 높았다. 이갈이군에서 남자가 여자보다 교정척도(K) 점수가 높게 나타났으며 여자는 편집증 척도점수가 높게 나타났다. 발병기간에 따른 차이는 없었으며 이갈이 종류의 비교에서는 이악물기형이 다른형보다 내향성 척도가 유의하게 높았다. 저작근 통증, 경통, 두통과 같은 동반된 통증 유무에 따른 차이는 없었다. 결 론 : 다면적 인성검사상 일부 항목에서 높은 점수를 나타낸 것으로 이갈이 환자의 심리적 특성을 규정짓기는 어려우나 이갈이군이 대조군에 비해서 다면적 인성검사상 모든 척도가 상승되어 있고, 이갈이의 성별, 가족력, 이갈이의 종류에 따라 일부 척도의 점수가 상승되어 있는 것은 이들이 서로 다른 심리적 특성을 가질 가능성을 시사한 것이라고 판단되며, 이는 치료에 있어서도 좀 더 개별화된 접근이 필요함을 시사한다. Objectives : The aim of this study was to evaluate the psychological characteristics of the patients with bruxism by Minnesota Multiphase Personality Inventory (MMPI). Methods : MMPI was administered to 87 patients(46 bruxism group and 41 control group) who had visited a local dental clinic from January to August 1998. Results : The bruxism group had a higher score than control group in Masculinity-Femininity (Mf) scale. There were no differences between bruxism group and control group on the distribution of Depression(D), Psychopatic Deviate(Pd), Paranoia(Pa), Psychasthenia(Pt) scales. The bruxism group with the family history showed higher score than the bruxism group without family history in Pd scale. Male bruxism group had a higher score than female bruxism group in Defensiveness(K) scale and female bruxism group had higher score than male bruxism group in Pa scale. The bruxism group of clenching type had a higher score than the bruxism group of mixed type in Social Introversion(Si) scale. There were no differences in MMPI score between those who had and did not have symptoms such as masticatory muscle pain, neck pain, and headache. Conclusion : It is concluded that individualized approach may be effective to the evaluation of psychological disturbances which might be related to sex, family history and, type of bruxism, while we did not find significant differences in personality characteristics between the bruxism and control groups.

지연성 운동장애의 유병율 및 위험인자 조사

반철식,김영훈,심주철 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.6

we examined 423 chronic psychiatric inpatients who had a history of at least three months total cumulative neuroleptic for tardive dyskinesia(TD). In this study, we used both structured scales of dyskinesia and videotape recording. Demographic clinical, and drug history data were collected to assess whether any of these factors was significantly associated with the presence of TD. Female sex, duration of hospitalization, length of neuroleptic treatment, and exposure to antiparkinsonian agents also were related to increased risk. However there was no significant relationship between the presence of TD and other factors including psychiatric diagnosis, daily dosage of neuroleptics, or history of alcohol, smoking, electroconvulsive therapy, head trauma. Interestingly, the history of tricyclic antidepressant medication was associated with decreased prevalence. Further work is needed to perform well-controlled prospective study.

불안의 형성과정에 있어서 뇌 Cholecystokinin의 역할

김영훈,심주철 대한생물치료정신의학회 1995 생물치료정신의학 Vol.1 No.2

Cholesystokinin(CCK) is one of the most abundant neuropeptides and its receptors are widely distributed throughout the central nervous system, especially in hypothalamus, limbic system, basal ganglia, hippocampus and cortex. CCK is co-localized or interacts with dopaminergic, noradrenergic, GABAergic and serotonergic neurotransmitter systems. lts functional roles are not fully defined, but it appears to mediate anxiety and it may participate in satiety, nociception and drug withdrawal. CCK/dopamin neurons in ventral tegmental area project their long pathways to limbic system and striatum and their roles in the pathogenesis of dopamine-related disorders such as schizophrenia are shortly described in this article. Cholecystokinin tetrapeptide(CCK-4) is suggested to have a potent panicogenic property in human. Both clinical and animal research suggests that ?? receptors mediate the panicogenic effects of CCK-4 and their antagonists provide an important advance in the treatment of anxiety disorder. The possible involvement of CCK in the pathogenesis of panic disorder is described briefly. The antagonistic action of imipramine on CCK-4-induced panic and that of 5-HT₃ on CCK release in nucleus accumbens are discussed. As described above, there is growing speculations that CCK might be implicated in the neurobiology of anxiety and its receptor agonists could be used in the treatment of anxiety in future.

도시 지역 알쯔하이머형 치매 환자를 대상으로 한 한국판 MMSE(MMSE-K)의 진단적 타당성 조사와 정신병리 평가

김민걸,이상수,이영호,이상경,안동성,윤성환,심주철,김용관,김영훈 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.6

연구목적 : 본 연구는 ①도시거주 노인한자들을 대상으로 알츠하이머형 치매의 진단에 있어서의 MMSE-K의 진단적 타당성을 조사하고 비치매 환자들과의 감별에 있어서의 MMSE-K 소항목별 민감도와 특이도를 평가하여 이 평가척도의 임상적 유용성을 검증하고,②도시거주 알츠하이머형 치매 환자들의 정신증상의 발생빈도를 알아보고, 인지기능의 장애정도와 정신병리의 심한 정도와의 상관성을 조사하고자 기획되었다. 연구방법 : 연구대상자는 치매환자 무료진료시 수진한 총 107명의 도시거주 55세이상의 노인들이었다. 연구대상자의 특성은 55∼69세 사이가 적었고. 일반노인에 비해 여자가 많았으며, 시설거주 노인의 비율이 높았다. 이들은 DSM-IV 치매기준. 신체이학적 검사. 임상검사소견. 신경학적 검사. Hachinski's Ischemic Scale, 병력 및 일상생활 수행능력평가. MMSE-K, BPRS, HDRS. HARS, Overt Aggression Scale. 수면양상 평가 등의 임상평가척도를 통한 인지기능 및 정신병리평가소견을 종합하여, 최종적으로 정신과 전문의 2인이 논의하여 진단되었다. 치매로 진단된 70명 중 52명이 알쯔하이머형 치매, 10명이 혈관성 치매, 1명이 혼합형 치매 7명이 기타 요인에 의한 치매로 분류되었다. 알쯔하이머형 치매로 분류된 52명중 MMSE-K 시행이 불가능하였던 2명을 제외한 50명의 환자군과 심한 신경정신질환이 없는 34명의 비치매군을 대상으로 하여 MMSE-K 및 그 11개 소항목의 진단적 타당성을 조사하였다. 이들 52명의 알쯔하이머형 치매 환자 중 위에 기술한 전체 임상평가과정을 신뢰성 있게 종료한 42명의 환자를 대상으로 정신중상의 발현빈도를 조사하였으며, 인지기능의 장애정도와 정신증상의 심한 정도간의 상관성을 조사하였다. 연구결과 : 1) MMSE-K는 알쯔하이머형 치매 진단에 있어서 위양성율 8.0%, 민감도 82%의 높은 타당도를 보였다. 2) MMBE-K 항목 중 판단 항목의 평균치는 알쯔하이머형 치매군과 비치매군에서 차이가 없었다. 소항목 중 알쯔하이머형 치매를 진단하는데 있어 민감도 및 특이도가 70% 이상인 항목은 시간 및 장소에 대한 지남력, 두 개의 오각형 복사의 3항목이었다. 3) 42명의 알쯔하이머형 치매 환자들이 나타낸 정신중상은 언어 공격성(38.5%). 우울(34.6%). 불면 (32.7%) 등이 많았고. 망상과 환각을 나타낸 환자도 각각 15.4%, 13.5%나 되었다. 4) 인지기능의 장애가 심할수록 BPRS총점이 증가하는 경향을 보였으나 통계적 유의성은 없었고, thinking disturbance 세부항목군의 점수는 유의하게 높아져, 인지기능의 장애가 심할수록 사고장애가 심해졌다(p<0.01). 결 론: MMSE-K는 매우 유용한 평가척도이나 그 소항목의 타당성에 대한 재검증을 요한다. 알쯔하이머형치매환자들은 인지기능의 장애외에도 공격성, 우울증. 불안, 망상. 환각 등의 많은 정신증상을 갖고 있어 적극적인 치료를 요한다. Objectives : The purpose of present study was to determine the validity of MMSE-K and its items in a group of urban patients with dementia of Alzheimer type and investigate the frequency of psychiatric symptoms and the correlation between the severity of cognitive impairment and that of psychopathology in them. Methods : The subjects were 107 residents, aged over 55, of an urban community, who participated voluntarily in a free medical service for dementia patients. At first, MMSE-K were administered to all the participients to screen for the cognitive impairment. They were diagnosed mainly by the criteria of DSM-IV for dementia of Alzheimer type. Other diagnostic procedures were performed at that time and these included : a history taking for the past and present medical and psychiatric illnesses of the subject and its family members, physical and neurological examinations, clinical clinical evaluations using several psychiatric symptom rating scales such as BPRS, HDRS, HARS and Over Aggression Scale, Hachinski's Ishccmic Scale, evaluations for sleep disturbances and behavioral problems in daily in living. The majority, of total 72 subjects who were evaluated as having cognitive dysfunctions, were the patients with dementia of Alzheimer type 52 dementia of Alzheimer type, 12 vascular dementia, one mixed type of the two, and 7 others. We determined the validity of MMSE-K and its items in 52 subjects with dementia of Alzheimer type except the two, who could not respond well to the instructions of MMSE-K due to severe cognitive impairments, and 34 non-dementic subjects with only mild psychiatric symptoms. In 42 subjects with dementia of Alzheimer type who completed all the clinical rating scales with confidence, we investigated the frequency of psychiatric symptoms and the correlation between the severity of cognitive impairment and psychopathology. Results 1) The percent of fa1se positive in diagnosing dementia of Alzheimer type using MMSE-K was 8.0%, and the sensitivity of MMSE-K was 82% in our 107 urban subjects. 2) There were statistically significant differences in the the mean stores of all items except the Item, judgement, between the patients with dementia of Alzheimer type and non-dementic subjects(p <0.05). The two items, orientation for time and place, and the item, copy two pentagons, had the sensitivity and specificity over 70%. 3) The frequencies of behavioral and psychiatric symptoms in 42 patients with dementia of Alzheimer type were as fo11ows verbal aggression(50.0%), depression(46.2%), insomnia(30.8%), .... , hallucination(21.2%) and delusion(15.4%). 4) The more cognitive dysfunctions had the patient with dementia of Alzheimer type, the more higher scores in the thinking disturbance subscale of BPRS they showed(p <0.01). Conclusion : MMSE-K was proved to be a valid instrument to evaluate the cognitive impairments in patients with dementia of Alzheimer type, but the item, judgement, newly admitted to MMSE-K instead of a language item in MMSE, was proved to be lack of power to discriminate the dementic patient from non-dementia subjects. Our subject with dementia of Alzheimer type had revealed several behavioral and psychiatric symptoms other than cognitive dysfunctions, and those included depression, anxiety, insommnia, aggression, delusion and hallucination which needed intensive pharmacological interventions.